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ER EDUCATION OF MEDICAL MEN 



AN D ITS 



Influence on the Profession and the Public, 



BEING THE ADDRESS DELIVERED BEFORE THE AMERICAN 

ACADEMY OF MEDICINE, AT ITS FIFTH ANNUAL 

MEETING, HELD AT PROVIDENCE, R. L, 

SEPTEMBER 28, 1880. 



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President of the Academy, 



MEMBER OF THE BOARD OF MANAGERS OF THE HUDSON RIVER STATE HOSPITAL; 
OF THE COUNCIL OF THE UNIVERSITY OF THE CITY OF NEW YORK ; OF 
THE NEW YORK NEUROLOGICAL SOCIETY. CORRESPONDING MEMBER 
OF THE NEW YORK ACADEMY OF MEDICINE, AND OF THE MEDICO- 
LEGAL SOCIETY. HONORARY MEMBER OF THE NORTH CARO- 
LINA STATE MEDICAL SOCIETY, AND OF THE NEW 
YORK COUNTY MEDICAL SOCIETY, ETC., ETC. 



Published by Direction of the Academy 



NEW YORK : 

CHAS. L. BERMINGHAM & CO. 

1260 & 1262 Broadway, 

1880 




HIGHER EDUCATION OF MEDICAL MEN, AND ITS INFLUENCE 
ON THE PROFESSION AND THE PUBLIC. 

Being the address delivered before the American Academy of Medicine, at its fifth annual 
meeting held at Providence, R. I., September 28th, 1880. 



F. D. LENTE, A. M., M. D., 
President of the Academy, etc. 



Fellows of the American Academy of 
Medicine: — May we not hope that there was 
some inspiration in our choice of this good 
city as the seat of our fifth annual meeting, 
and that Providence may indeed aid us in 
our effort to advance the cause of Medical 
Science, and the good of mankind. 

In attempting the discharge of one of the 
duties devolving on the President of the 
Academy, I invite your attention to the con- 
sideration of the Higher Education of Med- 
ical Men, and its Influence on the Profes- 
sion and the Public. 

"To the practitioner who has realized the 
defects of his education, and to the people 
who employ him, this subject has a vitality 
which is progressive, nor can even the oldest 
and most influential educators continue to 
ignore its significance." This is the opening 
sentence of a very pertinent editorial, (refer- 
ring to medical education,) in the last (Sep- 
tember) number of a very live Western jour- 
nal. It is a subject, perhaps, inconveniently 
wide in its scope for this occasion, but the 
objects and motives, and the probable influ- 
ence of our association in the future, are so 
little understood, that it has been thought ad- 
visable, by others besides myself, not only to 
address you, but also the profession at large, 
and indirectly, the public beyond. The in- 
terests, in fact, of our profession are so in- 
terwoven with those of the public, that it 
would not be possible, even if desirable, to 
consider them separately. As civilization 
has advanced, this has become more and 
more apparent, and better and better appre- 
ciated by the general public; indeed it would 
not be difficult, at this day, to demonstrate 
that this advance has been largely due, and 



that, in future, it will be still more largely 
due to the advance of medical science. To 
the thoughtful citizen, who keeps himself an 
courant with the daily history of progress 
especially in sociology and general science, 
the newspaper press, the reports of the State 
Boards of Health, of Commissioners of Edu- 
cation, of medical and other scientific asso- 
ciations, and the individual communications 
of medical men to the popular as well as the 
professional journals, it will not require 
demonstration. These all illustrate the un- 
tiring and unselfish efforts of our profession 
in the prevention of disease and immorality; 
efforts directly opposed to their pecuniary 
success, often involving considerable pecuni- 
ary sacrifice; efforts, however, whose fruition 
brings its own reward to their authors, and 
which are also beginning to be appreciated 
by the intelligent and thoughtful portion of 
the American public. 

How do we stand to-day with regard to our 
relations with this public, especially with the 
cultivated classes? Have we that degree of 
the respect, the confidence, the veneration of 
these classes which was accorded to the medi- 
cal men of past ages, and is now accorded to 
those of other countries ? Do we occupy as 
favorable a position with regard to them as 
we did even in the early history of our coun- 
try, when medicine was in its infancy com- 
pared with its development at this day ? 
Are our relations with the press, the clergy, 
the law, the scientists, the literati, such as 
they should be ? Such as the rapid and suc- 
cessful progress of our science in the last half 
century entitles it to be ? Such as its unde- 
niable influence on the welfare and happiness 
of the nation should claim for it ? It is hard- 



4 



ly necessary to ask the question. We are all 
prepared to answer in the negative. Why is 
it so ? The fault is not in our grand calling, 
nor in the deficiencies of our science, which 
lays under contribution, indeed comprehends 
all sciences, but in her votaries. With them, 
comparative ignorance instead of the varied 
learning which should be their character- 
istic, is too often the rule. We meet 
here to day to raise our voice against this 
monstrous evil of society, and to pledge 
again our individual and united efforts. 
in common with our brethren all over the na- 
tion, who are striving in one way or another, 
towards the same end, for abating it at the 
earliest possible moment. 

If we would reform evils, we must thor- 
oughly appreciate and boldly face them. 
More than one of my predecessors have de- 
scribed in greater or less detail, their nature 
and extent. The whole profession, through 
its various representative bodies, and its col- 
leges, the very institutions which are perpetua- 
ting the abuses, have been crying out against 
them for nearly forty years; but still no reme- 
dy has been applied, none at least of a radi- 
cal nature. It is not a pleasant duty to un- 
cover the deficiencies, to expose the abuses 
of one's own profession; rather would we 
draw the veil of secrecy around them, The 
shafts of sarcasm and wit have, from time 
immemorial, been launched at us, and often 
unjustly: but we do not hesitate to arraign 
ourselves at the bar, when the interests of 
medicine, involving as they do, the interests 
of humanity, are imperilled. 

In the first place then, it may be justly 
charged that our standard of medical educa- 
tion has retrograded from its earliest founda- 
tion in this country, to the present time. 
"The first medical school, "says Dr. William 
Pepper,* " was founded in 1767," though it 
is stated by Dr. J. B. Beck,f that the State of 
New York is ' ' entitled to the honor of adopt- 
ing the first effectual measures for regulating 
the practice of medicine." This was in 1760, 
' ' when the General Assembly of the Prov- 
ince ordered that no person shall practice as 
physician or surgeon in the City of New 
York before he shall have been examined in 

* Introductory address before the Med. Dept. of 
the Univ. of Penna. 

t Address before the State Med. Soc. of New York. 



physic and surgery, and approved by one of 
His Majesty's Council, the judges of the Su- 
preme Court, the mayor of the city, or by 
any three or more of them, taking to their 
assistance for such examination such proper 
person or persons as they in their discretion, 
shall think fit." A fine was attached to in- 
fraction of this law. In 1772 a similar 
law was passed in New Jersey. Those 
eminent men who formed the University 
of Pennsylvania boasted, and "it was" says 
Dr. Pepper, no "idle boast," "that their 
scheme of medical education was to have 
as extensive and liberal a plan as in the 
most respectable European Seminaries, and 
that the utmost provision was made for ren- 
dering a degree a real mark of Honor, the 
reward only of distinguished learning and 
abilities." This plan was, "that all such 
students, as have not taken a degree in any 
college, shall, before admission to a degree 
in Physic, satisfy the Trustees and Professors 
of the college concerning their knowledge of 
the Latin tongue, and in such branches of 
Mathematics, Natural and Experimental 
Philosophy as shall be judged requisite for a 
medical education." Two grades were es- 
tablished: M. B. and M. D. It was only 
after taking one degree, and having practised 
under it for three years, and having attained 
the age of twenty-four, that the final degree 
could be secured. Remember, in this con- 
nection, what medical science was then and 
is now. It is like the difference between the 
vision of the unassisted eye and that to which 
the telescope carries us. Many of the 
branches which now constitute special pro- 
fessorships were then comparatively unknown 
and practically untaught. Yet we see that a 
far longer period of study and a more mature 
age were considered necessary to master the 
science then than now; and, above all, a far 
higher grade of preliminary training and ac- 
quirement. Here then lies the evil, and here 
lies the remedy in a nutshell — preliminary 
education. But let us probe the disease 
still further before we seek to apply the rem- 
edy. In 1849, when I graduated in the 
Medical Department of the University of the 
City of New York, there were six profes- 
sors, only three assistants, and only six 
branches taught, as in other similar institu- 
tions, and the term of study was about what 



it is now. It then required every moment of 
the industrious student's time to do justice to 
these branches, to dissect, and to attend the 
hospital clinique; and the facilities for neither 
were what they now are. There was no Mi- 
croscopy to study, no Laryngology, no Elec- 
trology, no Dermatology, no special instruc- 
tion in diseases of eye and ear, no laboratory 
work, no special instruction in the important 
class of nervous diseases, or insanity, ox- 
Medical Jurisprudence, or Hygiene, and the 
same was the case in other institutions. 
Now, each of these branches has an exten- 
sive literature of its own, and professorships 
or lectureships devoted specially to them. 
The area of study has, therefore, been more 
than doubled. What additional time has 
been added to the regular courses of our col- 
leges to meet this additional requirement of 
study ? Within a very recent period several 
colleges have adopted an additional session, 
and some have added one, two or three 
months to the session, but the large majority 
have made little or no addition which is obli- 
gatory. Plow is it possible, then, for the 
student to mentally digest all this new mat- 
ter which is crowded upon him during the 
few months over which the regular course 
extends ? For the small minority, who choose 
to avail themselves of the extra non-obliga- 
tory courses there may be some chance of ac- 
quiring a moderate acquaintance with most 
of the subjects: for the others it is a mere 
cramming; and we all know that knowledge 
thus acquired is but for a day, not for all 
time. 

Has there been such an improvement in 
our system of teaching as to compensate for 
this lack of time ? Evidently not. The only 
change from the old plan which might meet 
the increased demand is a careful grading of 
the classes. Yet, incredible as it may ap- 
pear to one unacquainted with the facts, the 
student, with so brief a period at his disposal 
for the acquisition of so much knowledge, 
and of such a varied character, and generally 
with little previous training or habit of study 
to assist him, is required to listen to the same 
lectures, to see the same experiments, to ob- 
serve the progress of diseases and their treat- 
ment with the most advanced pupils, and even 
with graduates, who have already attained 
some proficiency in the practice of medicine. 



Within the past year or two there are some 
honorable exceptions among the colleges, but 
I am referring to the almost universal custom. 

For some years after the establishment of 
medical teaching in this country there were 
but few schools, and the requirements for 
admission and graduation were kept up to a 
respectable standard. But, after independ- 
ence was declared, and the individual States 
assumed control of education, nearly all gov- 
ernment authority was withdrawn, and as 
charters for medical colleges were rarely, if 
ever, refused by legislatures,* they began to 
multiply until they increased from sixteen in 
1834 to eighty at this time, if we include the 
Homoeopathic and Eclectic colleges, which 
are legally on the same footing with our own, 
not to speak of the so-called bogus colleges, 
whose charters are a disgrace to the legisla- 
tures of some of our States and bring dis- 
credit on the whole country. For many years 
this increase has been in an accelerating ra- 
tio; for, according to Dr. Pepper's statistics 
(op cit), " the population between 1867 and 
1876 increased less than 8,000,000, but no 
less than twenty-one new regular medical 
schools were established." That the number 
of these colleges is far beyond the wants of 
the country will be apparent from the state- 
ment that in fourteen other countries, inclu- 
ding our neighbor Canada, the average is 
about one to every 2,250.000 of population, 
and there is no complaint in any of these 
countries of a want of doctors, except in 
F ranee and a few remote districts in Ireland 
and Scotland. 

As our colleges are, almost without excep- 
tion, private institutions, conducted at the 
expense of the professors, and supported by 
the fees of the students, it follows that, to 
keep them going without too great a pecuni- 
ary sacrifice, students must be had at all 
hazards, and hence follows a rivalry or com- 
petition, not for turning out good physicians, 
but a good number; hence the impossibility 
of exacting such a grade of preliminary re- 
quirement for matriculation, or such a stand- 

* The first law. however, which was passed after 
the War (in New York, 1792) recognized the impor- 
tance of the collegiate degree, inasmuch as it re- 
quired a student not possessing it to study an addi- 
tional year. In 1818 the Legislature of New York 
again recognized the importance of classical studies. 
— [Davis on Medical Education. 



ard of medical knowledge at graduation as 
their own sense of propriety and responsi- 
bility would prompt them to adopt; or, as 
Dr. Stille has more forcibly expressed it, 
" This it is which has destroyed the inde- 
pendence of the schools, and has compelled 
them to perpetuate a system of education 
which their judgment condemns and their 
conscience reprobates." "The great defect 
in Great Britain," says the author of the 
Carmichael Prize Essay for 1879, "of the 
present state of things is the admitted antag- 
onism which exists between the duty and the 
interests of the corporations. And it is to 
deal with this fact, and for no other reason, 
that the whole medical system is to be revo- 
lutionized." The General Medical Council 
appears to be powerless, and generally allows 
the colleges to do as they please. The con- 
sequence of this irresponsible multiplication 
of schools is a corresponding multiplication 
of physicians; so that the proportion to pop- 
ulation here is 1 to 600, according to Pep- 
per's tables, against an average of I to 3,800 
in 13 other countries in both hemispheres. 
The evils resulting, both directly and in- 
directly, from this excessive over production 
alone are of the most serious character, far- 
reaching in their influence, inimical if not 
destructive to that high social status of the 
profession as a body to which we are entitled 
by our constant devotion and liberal benefac- 
tions to the public interest, while it is equally 
opposed to the welfare of the individuals of 
that body. '.' A whole book," says a recent 
editorial in one of our best journals, "might 
be written upon the innumerable vicious re- 
sults of the overproduction of medical men." 
Grant for a moment that the hordes of 
physicians crowding every nook and corner 
of our immense territory are possessed of 
those mental and moral qualities which a 
liberal education commonly bestows, that 
they have acquired a fair theoretical and 
practical medical training besides the diplo- 
ma, which of itself, unfortunately, carries no 
such assurance, what is to become of them ? 
Statistics and careful investigation in differ- 
ent countries show that it requires a popula- 
tion of 2,500 to ensure a sufficient compen- 
sation to a physician. In this country it 
probably requires less. We will say 1,500. 
But there are only 6oo v and from this we 



must deduct 200 (Prof. Hamilton -allows 300) 
for charity practice and bad debts. To en- 
able him, then, to live as a gentleman occu- 
pying such a position in society should live, 
he must engage in some other pursuit in 
addition to his practice. A few succeed in 
this; but it is at the expense of serious dete- 
rioration of medical skill and knowledge. A 
large majority struggle along, compelled by 
ruinous competition to accept such inade- 
quate compensation that they are barely able 
to procure the necessaries of life, and have 
no means to supply themselves with a tithe 
of the necessary periodical literature which 
tells of the daily progress of medical science. 
The natural outcome of this is a loss of pro- 
fessional interest, habits of careless observa- 
tion and diagnosis, a gradual deterioration of 
that high principle of justice and honor in 
their social intercourse with each other with 
which they started out in life, and too often, 
in the scramble for the means of living or for 
family comforts, a degeneration into the con- 
temptible practices which, we know, are tend- 
ing to degrade the profession everywhere. 

But we are all painfully conscious that I 
have granted too much; that but a very small 
proportion enter upon life with any such 
qualifications as have been described.* The 
examinations before our Army and ' Navy 
Boards during our civil war; the horrible 
mistakes, both in medical and surgical prac- 
tice on the part of our regimental surgeons; 
the evidence of the professors themselves of 
our medical colleges, in their annual ad- 
dresses; the reports of the committees 
of the American Medical Association, year 
after year; the lamentable instances of 
gross ignorance and incapacity adduced 
before this Academy by my predeces- 
sors, render it unnecessary for me, at this 
time, to recapitulate, or to adduce any spe- 
cial cases, which, unfortunately, are but too 
abundant. 

*It is estimated that there are about 80,000 persons 
practising medicine in the United States, and that 
less than 5 per cent, of these have the degree of A. B % 
and that not more than 15 per cent, are capable of 
contributing to the literature of the profession. A 
distinguished physician of Pennsylvania., one of our 
fellows, says: "Leaving out Pittsburgh and Phila- 
delphia, and their counties, there are not two A. B.'s 
in each county. There are only two A. B.'s in my 
county, with eighty practitioners." 



7 



Let me not be misunderstood, or quoted 
as depreciating the condition of medical sci- 
ence in the United States. This by no 
means corresponds with the status of the 
medical profession, paradoxical as the state- 
ment may appear. In spite of the obstacles 
just referred to, and others yet to be noticed, 
we are certainly not behind any countiy in 
the world as regards our achievements in 
practical medicine and surgery, and are be- 
yond all in some of the branches of the latter 
— in the surgery of women, in the management 
of deformities and fractures for instance, to 
say nothing of the great discovery of Anaes- 
thesia; while, at the same time, this skill is 
more widely disseminated in this country 
than in any other. Our medical literature is 
beginning to command the respect of the 
world, many of our systematic treatises having 
been translated into several foreign lan- 
guages. In a late number of the London 
Lancet, the reviewer of a recent great work 
by American authors, "Buck's Hygiene and 
Public Health," makes this criticism: "To 
ay it is worthy the country of its origin is to 
say a great deal, but not more than is de- 
serves." Nevertheless the number of such 
works is ridiculously small compared to the 
talent and rich experience possessed by such 
large numbers of our distinguished physi- 
cians and surgeons. From the defective na- 
ture of their preliminary education, the ma- 
jority of these find it difficult, if not impos- 
sible, to write creditably. In the last num- 
ber (August) of Hays' Medical News and 
Abstract, there are fifty-three selections from 
various writers, and not one among them 
from an American author. We may point 
with pride to our Great National Medical 
Museum, the wonder and admiration of the 
medical world, a monument to the genius 
and foresight of the Surgeon-General, who, 
in the midst of unaccustomed and most ex- 
acting labors in the medical organization of 
our heterogeneous army, with its crowds of 
ignorant surgeons and hospital stewards, seized 
the time and opportunity to initiate and 
carry on such a work as this, and thus to 
make, the vast sacrifice of human life, inci- 
dent to such a war, a blessing to future arm- 
ies, and an invaluable inheritance to the de- 
scendants of those whose death or mutilation 
furnished the occasion and the materials for 



this noble institution. The National Medi" 
cal Library also has grown with the light- 
ning-like rapidity characteristic of everything 
American, and the present librarian, a dis- 
tinguished fellow of this Academy, to whose 
ability, perseverance and indefatigable labor 
it is mostly due, is now engaged on a work, 
which, to quote the words of the venerable 
Wendell Holmes, " will be to the nineteenth, 
all and more than all that the Bibliothicae, 
Anatomica, Chirurgica et Medicinas Practical 
were to the eighteenth century." All this is 
not inconsistent with what has been stated 
with regard to the ignorance of the mass of 
the profession. A profession will be judged, 
not by a few shining lights, but by the condi- 
tion of the body. " Every ignorant man." 
says Dr. Geo. E. Paget,* "has an injurious 
influence on the estimation in which the en- 
tire body is held. Plis demerits have a ten- 
dency to lower us throughout the circle in 
which he is known. The want of confidence 
in him, and the want of respect for him, be- 
get distrust and disrespect for the profession 
in general." 

First then, let me ask, how are we to limit 
the number of physicians ? One professor, 
in his annual address before the Council, has 
recently asked: "Why not follow the plan 
of the manufacturers, when the supply is 
largely in excess of the demand, — ' shut 
down; stop the manufacture.'" This might 
indeed improve the prospects of existing 
practitioners, but we wish to infuse a differ- 
ent class of men, who will themselves grad- 
ually thin out the ranks of the grossly incom- 
petent. Our course is plain enough — to make 
our system of instruction correspond, in some 
measure, to that which prevails in all other 
parts of the civilized world. We are all 
aware that nowhere is the door so widely 
open to entrance into the medical profession 
as here. Not only are the requirements for 
entrance into the medical colleges, and for 
the diploma, far higher in the old and princi- 
pal governments of Europe, but in such 
countries also as Australia, Chili, Venezuela 
and Cuba. By such a course, we would di- 
minish the quantity, and improve the quality. 
This practice of the colleges for fifty years, 
in first receiving students utterly unprepared 

*Address before the British Medical Association, at 
Cambridge. 



8 



by previous education, to commence the study 
of medicine, and then crowding them through 
to their graduation in the brief period of two 
sessions, comprising each only about five 
months, sometimes less, has fostered the idea 
in the minds of these students, and of the 
cultivated classes of the public, that the 
study of medicine is comparatively a very 
simple affair, requiring very moderate mental 
capacity, and very little previous education, 
that a knowledge of the qualities of a few 
drugs, and of their effects on the system, the 
ability to " set " a broken limb, tie a bleeding 
artery, dextrously amputate, to be able to 
distinguish, under a microscope, a blood cor- 
puscle from a urinary cast, and similar knowl- 
edge, are about the sum total of what is re- 
quisite for attaining the dignity of M. D. 
The ablest young men, accordingly, in most 
communities, betake themselves to law and 
politics or to mercantile pursuits, whose rank 
and file include a considerable number of our 
most highly educated gentlemen; sometimes 
to the ministry, which is known to require at 
least some classical knowledge, but whose 
reputation, like ours, is seriously impaired. 
The same obtains in England; Mr. Spencer 
Wells, in his address before the British Med- 
ical Association, says: '"'We should so order 
our schemes of education, whether conjoint 
or not, as to bring into the profession, as far 
as possible, young men who have the highest 
general culture to be obtained by an English 
education. Until this is secured, the flower 
of our University youth will still choose 
the Church or the Bar, the Army or 
the Navy, or some branch of the civil 
service of the State, where they at once 
take an enviable social position as members of 
an honorable profession." Those, in the 
United States, who feel it a disgrace to fol- 
low in the footsteps of their fathers, and to 
labor, or are too ignorant or too stupid to at- 
tempt law or theology, are apt to take up 
with medicine. Here in New England, 
where the best educational establishments are 
located, I am informed by one who has had 
the best opportunity for ascertaining the 
facts, that hardly one of the few who attain 
the highest rank in the classes, ever chooses 
the study of medicine, while the mass of 
those who fall by the way, and abandon their 
collegiate course, if they choose any profes- 



sion, enter upon that of medicine. In Eng- 
land the same fact is observed, not two per 
cent, of the physicians there are graduates of 
the universities, and their social status is 
worse than ours. The idea generally enter- 
tained among the cultivated classes is that a 
comparatively low grade of learning is re- 
quired for the study of medicine, or that high 
attainments will be wasted where their recip- 
ients are surrounded by, and likely to be out- 
stripped, in the struggle for fame and for- 
tune, by vastly inferior men, while, in the 
other professions the reverse usually obtains. 
This fact is also doubtless an incentive to 
young men possessing few or none of the nec- 
essary qualifications, to apply for admission 
into the profession. But a change is evidently 
taking place in this respect. The taste for, 
and the spread of scientific information 
among the intelligent and cultivated classes, 
even such as pertains more or less to medi- 
cine, especially to biological problems, to 
Hygiene and Preventive Medicine, as evi- 
denced by the numerous editorials on medi- 
cal topics in the daily and weekly press, the 
increasing demand for such journals as the 
Popular Science Monthly, the circulation of 
purely medical journals among the laity, all 
indicate that, in the near future, the ignorant 
physician will find it difficult to cloak his ig- 
norance, and that the quack will be unmask- 
ed. Even now, the physician, who is not 
thoroughly posted on the discoveries and im- 
provements daily heralded in medical period- 
ical literature, will perhaps not unfre- 
quently find that some of his patients are 
in advance of him. The time has passed 
when we could put off an intelligent querist 
with a shrug of the shoulder, or a wise look, 
a hard name, or a bit of scholastic lingo. Ev- 
idently the public are demanding of us better 
educated men. Appreciating as they do, 
more and more every day, the vast impor- 
tance of medical sciences to their most vital 
interests, not only to the safety of life, but to 
the prosperity of business, and the value of 
investments, they cannot afford to remain in- 
different to the condition of medical educa- 
tion: nor will they, when we show a united, 
determination to lift it from the comparatively 
degraded condition which it occupies in the 
United States. 

The time has come for action; not the dis- 



connected and partial changes which some of 
the colleges, here and there, to their credit, 
however, be it said, are undertaking, but a con- 
certed, simultaneous movement, which will 
elevate our institutions to somewhere near the 
level of those of the rest of the world. What 
shall this action be ? That we may form a 
better idea of what may be necessary in order 
to avoid the failures which have attended 
previous attempts, let us briefly review them. 
One would suppose that the necessary reform 
could be effected by the appointment of a dis- 
interested board of examiners composed of 
the best qualified men in the profession, who 
alone should have the power to authorize the 
granting of diplomas. But the few trials 
which have been made of this have not been 
encouraging. The State of New York has a 
Board of Censors, one from each congression- 
al district, appointed by the Medical Society, 
who are authorized to grant licenses. This, 
I believe, worked well for a short time. But 
gradually abuses in the appointment of the 
members crept in, probably through the with- 
ering taint of. politics, and it has become ob- 
solete. Then a law was passed empowering 
the Censors of the Medical Society to call be- 
fore them all practitioners, and to ascertain 
their qualifications. This would appear to 
be a certain method for getting rid of the 
quacks at least, as the law fixed a penalty for 
practicing without the license of the Censors. 
But it has been practically a dead letter. 
Now, a new law has been passed, which will 
probably meet with the same fate as the last. 
Then several of the colleges had boards of 
censors as examining boards, composed of 
eminent men who were not concerned direct- 
ly with the teaching. But their examinations 
were a sham, and diplomas were as easily 
earned as in the other colleges. A National 
Association of Medical Colleges has been at- 
tempting to effect some reform, and have fin- 
ally ventured to insist on a three years' 
course, but not until after 1882. But its suc- 
cess seems very problematical, since the 
small number of the great eastern colleges 
which had joined the association, have, for 
some unexplained reason, withdrawn. It is 
to be hoped that the southern and western 
colleges will not be discouraged by this de- 
fection. Reform in medical education was 
also one of the objects of the American Med- 



ical Association, and committees on reform 
have been repeatedly appointed and dis- 
charged, and one president after another has 
given the best advice with so little result that 
the whole subject seems, of late, to have been 
given up in despair. In England, those who 
have been aiming at reform have met with 
similar difficulties, and two years subsequent 
to the founding of our Academy, have settled 
upon the plan which we had proposed. But 
they are confronted by difficulties which do 
not exist here, some of their institutions hav- 
ing vested rights, with which they are loath 
to part, and which Parliament seems to 
guard with jealous care. Although they have 
only nineteen licensing bodies in the United 
Kingdom, they have so far found it impossi- 
ble to form a combination for what appears 
to be a sine qua non — uniformity in prelimi- 
nary requirement. 

Preliminary examination has been urged 
as affording the best means for excluding im- 
proper candidates. And some of our colleges 
have adopted it, but what does this examina- 
tion amount to ? As indicated in their annual 
announcements, it is less comprehensive than 
that required for entering the Freshman class 
of the most ordinary literary college; not only 
is Greek but even Latin entirely left out, or 
some modern language allowed as a substi- 
tute. But it is to be feared that the whole 
affair is a sham, for one of the most promi- 
nent colleges, in one of our large cities, after 
cutting it down on paper to very insignifi- 
cant proportions, has never put it into execu- 
tion, and, as I learn from good authority, 
does not propose to do so. A preliminary ex- 
amination by the faculty of a college, es- 
pecially by one which is not thoroughly en- 
dowed, is valueless. It should be by an in- 
dependent board, and better by a board not 
consisting of medical men at all. This is 
Sir William Gull's idea expressed in 1877 be- 
fore the Grand Medical Council of Great 
Britain. He said, moreover, "up to this 
time, I may say that the preliminary educa- 
tion examination has been good for nothing as 
a means of selecting men for entering the 
profession ; or for rejecting those who have not 
sufficient intellectual training." . In France 
they have no preliminary examination, but re- 
quire the Baccalaureate degree only. As an 
instance of the futility of preliminary exami- 



IO 



nations by the faculty of colleges, I may re- 
fer to a recent case which happened on the 
other side. "Recently" says Dr. Laffan,* 
"the Irish College of Surgeons rejected a 
candidate again and again for gross incom- 
petency, and Trinity College which has al- 
ways enjoyed an exceptionally high reputa- 
tion for strictness, admitted him with flying 
colors." Nor is this an isolated case. It is 
noted that, in Great Britain, within a few 
years, examinations have become more strict, 
and the boast is that a large percentage have 
been rejected. But, according to the authori- 
ty just quoted, it is also noted that but few of 
those rejected are obliged to abandon the 
profession. " They find at the last pinch, 
some portal large enough to admit them." 
Examination, indeed, as almost universally 
conducted, is a most imperfect test of knowl- 
edge. It can seldom discriminate between 
information crammed into the memory, and 
that which is assimilated and useful. It can- 
not tell whether it has been acquired in such 
a manner as to develop and strengthen the 
faculties of the mind, or whether, on the 
contrary, it has as often happens, weakened 
those faculties by overburthening them, and 
wearying the memory. In fact, examina- 
tions whether in our public or private schools, 
in our literary or medical colleges, are a mere 
deception and cloak to cover up deficiencies 
in teaching on the part of the instructors, and 
ignorance on the part of the pupils. In Ger 
many, where the best system of education is 
supposed to exist, examinations ars not relied 
on as a test, or as a correction of ignorance. 
We may be certain that these preliminary ex- 
aminations, which are so exercising the minds 
of our college faculties, and are given such 
prominence in their announcements when 
once decided upon, will result in the usual 
failure. By what means can we ascertain 
whether, in all the colleges adopting them, 
they are faithfully conducted ? The fatal 
competition for numbers, the bane of our 
system, will certainly prevent uniformity in 
this test. 

In the face of all these failures, what ad- 
ditional means of reform have we to propose ? 

The objects of the Academy are thus 
briefly stated in the Constitution: 

* Carmichael Prize Essay, 1879. 



1st. To bring those who are alumni of 
classical, scientific and medical schools into 
closer relations with each other. 

2d. To encourage young men to pursue 
regular courses of study in classical and sci- 
entific institutions before entering upon the 
study of medicine. 

3d. To extend the bounds of medical sci- 
ence, to elevate the profession, to relieve hu- 
man suffering, and to prevent disease. 

By bringing together in one body, from all 
parts of our country, the most highly educa- 
ted members of the profession, those who 
have received a classical and scientific train- 
ing preliminary to their medical education, 
and enlisting their efforts, individually and 
collectively, each in his own sphere of influ- 
ence, we may do much towards encouraging 
young men to pursue a regular course in a 
literary college before entering upon the 
study of medicine; and, for a time our action 
must be confined to this, but our endeavor 
must constantly be to shorten the period be- 
tween this and the day when all respectable 
medical colleges shall not only encourage, 
but compel, the young men of our country, be- 
fore entering their portals, to show that they 
have mastered such studies as can only, in 
this enlightened age, render them worthy of 
such admission. What test then shall we pro- 
pose to the colleges ? We have seen how 
difficult it is to enforce proper preliminary 
examinations, and how liable to failure the 
plan would be if adopted. We would pro- 
pose, then, that no one should be allowed to 
matriculate as a medical student who has not 
acquired the degree of A. B. from a respect- 
able college. There could be no evasion of 
this test on the part of any college ; no such 
thing as one college taking advantage of 
another. A diploma representing a four years' 
course, and at least two years of preparatory 
study must be shown; and any attempt to 
evade this must be promptly detected, as the 
name of each matriculant would be followed 
in the catalogue by the degree, and the name 
of the college whence obtained. We cannot, 
if we would, force the colleges to adopt any 
test. They are, unfortunately, subject to 
no exterior control. They will do as they 
please, but we can set an example. 

This proposition will perhaps strike those 
who have not given the subject mature con- 



II 



sideration, as Utopian, while others will have 
numerous objections to urge against it. 
Some of them we may anticipate. Some 
have already been privately advanced. In 
the first place, they point to those distin- 
guished lights in the profession, in this and 
other countries, who have attained the envi- 
able positions they occupy, unaided by classi- 
cal or scientific training. But these are very 
exceptional cases, to be found in all profes- 
sions and in all walks of life; men possessing 
those transcendent qualities of originality, 
energy and genius, which enable them to 
triumph over any deficiency of educa- 
tion. But the history of such men, as 
that of John Hunter for example, will show 
that they have often been painfully conscious 
of a great want, the possession of which 
would have saved them a vast amount of la- 
bor, and perhaps, at times, mortification. It 
is also true, as has been alleged, that a large 
majority of the professors in our medical 
schools, many of the ablest of them, are not 
entitled to fellowship in the Academy. Many 
of them we would be glad to number among 
our fellows if we could. But it would be 
hazardous to make exceptions. I have dis- 
covered, however, by conversation with some 
of these gentlemen, and by correspondence 
with others, that they did not enter on their 
professional career entirely destitute of col- 
legiate training. A considerable proportion 
passed through one or more of the classes of 
the college curriculum, but left before ob- 
taining a diploma. Some being over-anxious 
to commence the study of medicine, and not, 
at the time, attaching much importance to 
the possession of a degree, others from ill 
health or other causes. Many of these gen- 
tlemen have hastened to repair their defici- 
encies, while others not unfrequently offend 
the ears of better educated men, even of 
their pupils, by gross grammatical errors. It 
is nothing to boast of, and not calculated to 
elevate us in the esteem of the educated pub- 
lic, that a large majority of our medical pro- 
fessors are destitute of collegiate training, 
however able they may be as teachers in their 
particular branches of medical science. Ow- 
ing to the laxity of the examinations in our 
literary colleges, and the indiscriminate man- 
ner in which the degree of A. M. is con- 
ferred, it may be urged that it carries no as- 



surance of any considerable amount of 
scholarly attainment or mental training. This 
must be admitted. Still, it must also be ad- 
mitted that the degrees of A. B. and A. M. 
conferred in course, can only be obtained, in 
respectable institutions, after a certain term 
of varied study, and that they do carry the 
assurance that their recipients have not only 
passed through the curriculum of a respecta- 
ble college, embracing four years of study, 
but through a preparatory course of two or 
three years, - and have, after gradua- 
tion, studied a profession, or engaged 
in literary pursuits for two or three 
years additional, or have submitted to a 
special examination. That is to say, whether 
they have retained much actual knowledge of 
their previous studies, they must have formed, 
to some extent, habits of study, must have 
acquired some method, something of the art 
of mental application, so necessary for enter- 
ing upon the study of the difficult branches 
of medical science, and will be able at least 
to comprehend the nomenclature of their 
profession; therefore that they are far more 
desirable candidates, as a class, than those 
who are not in possession of degrees. We 
will, of course, be met with the objection 
that there is too much time wasted, in the 
ordinary college curriculum, with the classics. 
It is not necessary, however, that I should 
enter upon the discussion of this question, 
even if time permitted, nor that I should at- 
tempt a defence of the time-honored system, 
which has been so successful in the past, but 
which, like everything human, must change 
and submit to the modifications suited to the 
advance of civilization and science. It will 
be denied, however, I think, by few educa- 
ted persons that the study of the classics has 
an importance distinct from mere mental 
training. Even Tyndall has remarked that 
"as long as the ancient languages are the 
means of access to the ancient mind, they 
must ever be of priceless value to human- 
ity." It has been suggested that if the clas- 
sics were differently taught, their great value 
in disciplining the mind would be better ap- 
preciated. " That if Latin and Greek were 
taught in a scientific way, in relation to mod- 
ern languages, they would become, in being 
so taught, rather the languages of the living 
than the dead," There is no doubt that the 



12 



very imperfect and uninteresting methods of 
teaching the classics, devoting attention mere- 
ly to their correct and generally literal trans- 
lation, and the grammatical construction of 
sentences, and paying no regard to the ' ' style 
and material of the ancient writers and ora- 
tors," has had much to do with the deprecia- 
tion into which these studies have lately 
fallen. The great strides which Physical 
Science has made and is making must require 
some change in the preparation which is to fit 
our youth to cope with its problems; and this 
change will undoubtedly be made soon 
enough. The discussion, which is now be- 
ing so hotly waged between the conservatives 
in education and the extreme utilitarians, 
will doubtless eventuate in the adoption of a 
medium course on the part of the colleges, 
and, in the meantime, we must accept the 
curriculum of any reputable college as we 
find it, only looking to the duration of the 
term of study required for graduation. 

Will it be charged that we are going too 
fast. That we are radical and revolutionary 
in exacting such a standard? My lamented 
friend, the late Henry S. Hewitt, in his ad- 
dress before the Alumni Association of the 
Medical Department of the University of New 
York twelve years ago, said, in relation to 
the evils now complained of: ' 'The remedy, so 
far as our profession is concerned, lies in our 
own hands. t Let us insist that every candi- 
date for admission into a medical school shall 
present his diploma from an incorporated 
college of rank equal to Harvard, or Yale, 
or Columbia, or the University, or submit to 
an examination, and be rated accordingly, 
with reference to subsequent degrees." Look 
at the condition of the profession in Great 
Britain. They are clamoring there for a 
higher standard, are complaining there as 
here, that the social status of the profession 
is being lowered by the admission of unedu- 
cated men; yet their preliminary require- 
ments are far higher than ours, and their 
final examination for the degree far more 
rigid than ours, and their term of study 
much longer. We may be referred to the 
fact that great improvements are proposed, 
and some instituted in our colleges; that the 
term of study is being lengthened, the 
classes, in some instances, graded, frequent 
examinations instituted, increased laboratory 



and clinical work insisted on, that indepen- 
dent boards of examiners have been proposed 
and perhaps secured. I have no disposition 
to undervalue the decided improvements 
which many of the colleges, especially in the 
West, have recently made, and the disposi- 
tion to do all in their power, perhaps, to aid 
the cause of higher medical education, while 
older and more distinguished institutions, to 
borrow again the language of a medical edi- 
tor, " are halting between two opinions, 
which are born of a desire for dividends on 
the one hand, and a wish to avoid the dis- 
grace which comes from the propagation of 
ignorant doctors on the other." Whether 
these efforts are compelled " by outside pres- 
sure rather than from inside growth," as the 
editor charges, I do not choose to enquire. I 
accept the fact as a harbinger of what must 
soon come. But even if these efforts, in the 
course of the next decade, should eventuate 
in the greatest amount of improvement which 
the most sanguine could expect, the condition 
of the profession in Great Britain, is such as 
to indicate that no amount of reform short of 
a radical change in our rules for matricula- 
tion, a complete revolution in our ideas of 
preliminary requirement, and of our method 
of establishing its character, will give us that 
which we require, suitable material for the 
manufacture of physicians. 

Shall we be told that our association is ex- 
clusive, that our rule would turn away num- 
bers of the most worthy young men of the 
country, who have been unable, from pecuni- 
ary or other unavoidable circumstances, to ac- 
quire the necessary degrees ? This objection 
might have had some weight twenty or possible 
ten years ago; certainly not now, when our liter- 
ary colleges are scattered in profusion, by the 
unexampled liberality of our State Govern- 
ments, over every inhabited portion of our do- 
main, where these degrees can be obtained with 
such facility, and at such trifling expense, when 
the children of the farmer, the mechanic, and 
even the laborer, are offered, free of charge, 
the opportunity of a liberal education. An 
example just occurs to me to illustrate what 
the energetic but the impecunious American 
youth may accomplish. A few years ago, a 
young man wished to graduate at Cornell 
University. He was too poor to pay his ex- 
penses, light as they are in that excellent 



*3 



institution. He commenced work therefore 
as a bricklayer on some of the college build- 
ings. He commenced his studies also; he 
worked hard and he studied hard. He 
ceased study for a couple of years in order 
to lay up a little money to enable him to go 
on more satisfactorily. He finally sur- 
mounted all difficulties as any man of perse- 
verance and pluck will, and completed his 
course, got his degree; and now, only a few 
years after, he is becoming one of the noted 
scientists of the day, and, on the recom- 
mendation of several distinguished savants, 
has been appointed to a high position in one 
of the scientific departments under the Gen- 
eral Government. I assert that any youth 
who has not the ambition and the energy 
and the patience thus to spend a few years in 
necessary preparation, when his State and his 
country are holding out to him the helping 
hand, is not fit to enter the sacred precincts 
of Medical Science, to cope with the emer- 
gencies and responsibilities of medical prac- 
tice. But, even if the case were different, 
the fact that this is a free country, and that 
every man, whether he be ignorant, or 
learned, whether he can even sign his name 
or not, is entitled to a voice in the choice of 
his rulers, and in shaping governmental 
policy, is no 'argument in favor of liberalism 
in admission to the professions, especially 
the medical profession: for, if there is any 
which should be exclusive, which sliould, 
more than another, sedulously guard its doors 
against unworthy intrusion, it is ours. 
Whether we exist in a despotism, a monar- 
chy, or a republic, our rules should be the 
same; our diplomas should signify the same 
in one case as in another, that its recipient 
has had all the advantages, all the training, 
all the ennobling and humanizing influences, 
which only a liberal education can give; not 
a training of two or three years, but of a 
sufficient length of time to meet the require- 
ments of the age, and of the present ad- 
vanced state of medical science. 

Can any one advance a good reason at this 
epoch of our history, when our common school 
system throughout the country is the admira- 
tion, and the amount of money expended on 
it, the wonder of European nations,* when 

* It is not remarkable that the vast extent of our 



we are outstripping almost every nation in 
agriculture, in manufactures, in important 
discoveries in science, and art, in almost 
everything which marks a great and prosper- 
ous nation, why our people should not have 
the benefit of as well-educated physicians as 
any country in the world ? Why our prelimin- 
ary training, our term of study should not be as 
protracted, and our requirements for degrees 
the same as in France, or Austria, or Germany, 
or, at least, as in Cuba or Chili. I presume I 
am reflectingthe sentiment of this Academy 
when I say that I do not believe there is any 
valid reason; and that if the profession will 
unite with us, as we hope and expect they 
eventually will, in insisting upon the higher 
standard which we propose, the time will 
soon come when we shall be rid of the super- 
fluous members, who now jostle each other in 
disgraceful competition; and, above all, of 
those who have the honorable title of M.D., 
without the qualifications of head or heart, 
which would entitle them to it, and who are 
dragging us down to lower and lower depths 
of depreciation. This it is, and this only 
which distinguishes us from the other medical 
societies of the country, that the guarantee 
of a liberal education is required for member- 
ship, and that we express the opinion in our 
constitution, that a liberal education is abso- 
lutely requisite for entering upon the study of 
medicine. This gives to our diploma a dif- 
ferent significance from that of all other so- 
cieties, and when it shall have become gener- 

common school system, and the vast sums expended on 
it should have attracted attention and commendation 
but it would be tar more commendable if the investiga- 
tion, to which it has lately been subjected, had devel- 
oped the fact that less money had been expended and 
more benefit derived from it. It has lately been as- 
serted by those who have had the best means of judg- 
ing, that fully one half of the money appropriated is 
wasted. Even in Massachusetts such is the fact; and 
there, one-fifth of the whole amonnt of the taxes 
is appropriated to the schools. In fact, to some 
extent, it is worse than wasted, since the lives and 
health of the pupils are endangered by the bad venti- 
lation and bad drainage of the school buildings and 
other violations of the laws of health. Nothing short 
of a complete revolution in the methods of teaching 
will help the matter; and this revolution has happily 
been inaugurated at Quincy, Mass., and the " Quincy 
System" has been studied on the spot by hundreds of 
educators, whom interest or curiosity has drawn there 
This system is, however, by no means perfect, and has 
faults which will require correction. 



H 



ally understood abroad, will entitle its pos- 
sessor to a position there, and to a recognition 
by bodies entitled to grant licenses to practise 
which it would be difficult for him otherwise to 
acquire. This does not, however, constitute 
any antagonism between us and our sister so- 
cieties, state and national; we draw our fel- 
lows largely from them, we expect to work 
with them, and that they will work with us, 
as soon as they fully understand our aims. 
We all equally appreciate the great necessity, 
and are all equally anxious for reform. Be- 
cause certain prominent members of the pro- 
fession are excluded from fellowship by an ar- 
ticle in the Constitution, do we expect that 
they will chafe at it, or sneer at us, or endea- 
vor to thwart us in our efforts ? I should blush 
to think that the representative men in such 
a profession as ours could be so narrow- 
minded. No ! they fully appreciate the vital 
importance of stich an article. This is not 
mere individual opinion. I have conversed 
and corresponded with these gentlemen. 
They express a full appreciation of the impor- 
tance of this movement, though they may 
differ with us with regard to some of its de- 
tails. If we persevere, if we remain true to 
our principles and our Academy, we shall 
eventually receive their valuable aid. If they 
are actuated by no more commendable motive 
than self-interest, many of them have sons 
who are being thoroughly trained to become 
what physicians should be, who are spending 
a large amount of money, and a valuable por- 
tion of their life in obtaining just such an ed- 
ucation as we are insisting on; and they, least 
of all, would be likely to oppose an effort de- 
signed for the protection of this very class. 

I have, perhaps, already overtaxed your 
patience in endeavoring to do justice to the 
various topics incident to my subject, and 
which have seemed to demand consideration, 
and still have not alluded to some of the most 
important, These, after a brief notice, must 
be left for my successors, who will, doubtless, 
be able to present them more forcibly than I 
could hope to do. 

The degree of A. B., though a sine qua non 
in medical reform, is not a panacea for all 
our ills. Crinical teaching in the hospitals 
needs thorough revision. Through a want 
of system, of some authoritative super- 
vision over the lectures, and other causes, 



which it may not be wise to mention 
here, the inestimable benefits of our 
great hospitals, built and kept up at 
such an enormous outlay, are enjoyed by 
comparatively few. In consequence of this 
want of system, the pi - actical advantages 
available to the majority of students in our 
large cities, with their numerous hospitals, 
are not so far superior to those of the smaller 
towns as we have been in the habit of claim- 
ing, which latter having fewer clinical facili- 
ties, utilize them to a greater extent. 

The importance of an independent State 
Board of Examiners in Medicine has already 
been incidentally alluded to. Professor 
Mercer, of Syracuse Unversity (address be- 
fore the Council 1878) says: " We are pre- 
pared to petition the Legislature to appoint a 
Medical Board of Regents to examine all the 
candidates from the colleges of the State for 
the degree of M. D." He also says, with 
truth, that ' ' the college which shuns or fears 
an independent examination of its candidates 
for graduation is to be looked upon with sus- 
picion. The college that could not success- 
fully educate for such an examination ought 
not to be permitted to educate for any other." 
Such a law has been in existence in the State 
of New York for years, but the students are 
not compelled to appear before the board, and 
it has been, like .all other medical laws, a 
dead letter. If we could devise some plan 
for the proper constitution of such a board, 
and to make it compulsory on the colleges to 
send their students before it, the advantage 
to medical education would be great. Com- 
petent and faithful examiners are undoubt- 
edly hard to find. Outside of the faculties of 
our colleges, it would probably be impossible 
to find them. But the plan of conjoint boards, 
which is agitating the medical mind at this 
time in Great Britain, would probably work 
well, especially if written examinations were 
mostly relied on, and if the examination 
papers should appear before the board by 
numbers instead of by names. 

Another favor the medical profession might 
successfully ask of the Legislature, that they 
cease granting charters to any more colleges 
without the approval of the State Medical 
Society. The discredit and ridicule which 
the bogus medical colleges of Philadelphia 
and Cincinnati, chartered by their respec- 



*5 



ive States, have brought on the country 
abroad should be a warning to all Legisla- 
tures to ask the counsel of the State Society 
previous to any future action. 

The manner of choosing our professors 
might be improved with decided advantage 
to medical education, though it must be ad- 
mitted that the present plan, faulty as it is, 
has usually furnished an able corps of teach- 
ers. One college has initiated the concours, 
which works so well in France. Without en- 
dowment, however, the plan might not apply 
to all our colleges. 

Even if the colleges should require a three 
years course, and nine months in the year, it 
would still be impossible to impart to the 
most industrious student a respectable knowl- 
edge of all the branches of medical science. 
In fact, no mind can grasp the whole range 
of the science .at this day. There are certain 
branches which must finally be left to a post 
graduate course, or to special study after 
graduation. A certain degree of proficiency 
in them must, 'of course, be required of the 
student who is to become a general practi- 
tioner, especially if he is to practice in the 
rural districts or small towns. With all such 
branches as Ophthalmology, Otology, Micro- 
scopy, Analytical Chemistry, Medical Juris- 
prudence, Insanity, Diseases of the Nervous 
System, Hygiene and State Medicine, it is 
simply impossible that the medical student 
can become thoroughly conversant during the 
ordinary curriculum, even if greatly enlarged. 
Nor is it desirable that lie should. Certain 
men, who desire to'become specialists or ex- 
perts, after graduation, will select certain 
branches, and obtain a special diploma; and 
they, and they alone, will, it is hoped, in fu- 
ture meet the wants of medical jurisprudence, 
and that we shall cease to find a quasi expert 
in every block in a city and every street in a 
village.* The profession probably sustains 
no greater discredit from any one source than 
the conflicting opinions of pseudo experts. 
My friend Prof. Thomson, of the University 
of the City of New York, in his annual ad- 
dress before the New York Academy of Med- 
icine, graphically portrays the exigencies of 

*Michigan, which has inaugurated many medical 
reforms, has initiated a method for the instruction and 
licensing of sanitary experts, by means of the State 
Board of Health. 



the average practitioner's life in this country, 
and the great importance to him and the stu- 
dent just graduated, of post graduate lec- 
tureships. But these should be really and not 
merely nominally post graduate; that is, they 
should be of such a character as to reach the 
needs of practitioners, and not, as is too of- 
ten the case, toned down to the compre- 
hension of first and second-course students. 
It has been demonstrated that such courses, 
if genuine, will pay, 

Intimately connected with the last topic is 
endowment, which is too important to be en- 
tirely ignored. It would be easy to enter upon 
such a mathematical calculation as would 
demonstrate that, through our gratuitous 
practice among the poor, and our hygienic 
labors, with the consequent saving of life, 
and diminution of disease, with a correspond- 
ing saving of expense to the State, the latter 
could well afford to endow all the medical 
colleges recipary for the wants of the public, 
and have a surplus in the treasury. Years 
ago, when Hygiene and Preventive Medicine 
were in their infancy, the celebrated New York 
surgeon and scholar, Alexander H. Stevens, 
in an address before the State Medical So- 
ciety,* made this clear by actual figures, and 
the celebrated Dr. Farr of England has late- 
ly done the same. But I concur with my dis- 
tinguished predecessor, Prof. Hamilton, that 
the gain to medical education through State 
endowment, would be a doubtful one, and 
that any union of Medicine and State is to be 
as much deprecated by us as that of Church 
and State. We must look to other quarters 
for our endowments, and we will not look in 
vain, if we show ourselves worthy of them, 
and if we use the influence, by no means a 
trifling one, which we individually possess, 
according to our worth. What cheaper or 
better method could a man desire for hand- 
ing his name down to posterity than by 
founding such lectureships as the Lettsomian, 
the Lumleian, the Croonian, and the Goul- 
stonian? Annually, the reading public is 
reminded of the professional patriotism and 
foresight of the distinguished founders of 
those lectures. Their names are annually 
rendered as fresh in our minds as they were 



*" A Plea of Humanity in behalf of Medical Edu- 
cation." 



i6 



in the minds of the public hundreds of years 
ago, when they lived. What more noble or 
fitting monument to commemorate a life well 
spent, and the lofty sentiments of their 
founders, than these world-renowned lecture- 
ships, reflecting, each year, the foremost ad- 
vances of our ever advancing science? 
Through the lips of their eminent successors, 
year after year, and century after century, they 
still speak to us words of wisdom, and we 
still hear the tones of their voices, encourag- 
ing us to emulate their example and to perse- 
vere in the path of usefulness, of rectitude 
and honor. Within the past year or two their 
example is beginning to bear fruit here in the 
foundation of lectureships in our large cities. 
The cost of a monument of bronze or marble 
to mark the resting place of some wealthy in- 
dividual, such as we now and then see stand- 
ing in some quiet nook in some secluded 



cemetery, hidden from and forgotten by the 
busy world, would serve to found two, per- 
haps three of those invaluable lectures for the 
higher education of physicians, which would 
place the names of their founders in such a 
position, for all time, that "he who runs may 
read," Monumentum are perennium. It 
should be one of the aims of this Academy to 
use its influence to compass the foundation of 
such lectureships as we need to supplement 
the teaching of our schools, and to help the 
busy practitioner, who desires to make up for 
deficiencies of which he only becomes con- 
scious after he has been a few years in prac- 
tice. They might be delivered, each year, 
in the city where the Academy holds its ses- 
sion, thus affording the fellows an opportuni- 
ty to profit by them, and serving as an addi- 
tional inducement to regular attendance on 
the meetings. 



Note. — It was my intention to have mentioned, in the body of my address, or in a foot- 
note, when referring to the "bogus" diplomas of Philadelphia and other cities, the praise- 
worthy efforts of the ''Philadelphia Record" which, although having no special interest in 
the Medical Profession, but simply for the honor of its city and country, undertook to do, and 
did do, single-handed, that which neither the Legislature, nor the Courts, nor the Medical 
Profession had made any great effort to accomplish, and, but for which action, Buchanan 
would now be adding to the list of the 11,000 diplomas which he had previously scattered all 
over the world, to the ridicule, and disgrace of our country at home and abroad. 



"1 

J 



HER EDUCATION " OF MEDICAL H 




AND ITS 



Influence on the Profession and the Public, 



BEING THE ADDRESS DELIVERED BEFORE THE AMERICAN 

ACADEMY OF MEDICINE, AT ITS FIFTH ANNUAL 

MEETING, HELD AT PROVIDENCE, R. I., 

SEPTEMBER 28, 1880. 



B Y 



IB 1 . IX ZLZEIDTTS; .A-_JUL\, JUL.JD-, 

President of the Academy, 

MEMBER OF THE BOARD OF MANAGERS OF THE HUDSON RIVER STATE HOSPITAL; 
OF THE COUNCIL OF THE UNIVERSITY OF THE CIT^ OF NEW YORK ; OF 
THE NEW YORK NEUROLOGICAL SOCIETY. CORRESPONDING MEMBER 
OF THE NEW YORK ACADEMY OF MEDICINE, AND OF THE MEDICO- 
LEGAL SOCIETY. HONORARY MEMBER OF THE NORTH CARO- 
LINA STATE MEDICAL SOCIETY, AND OF THE NEW 
YORK COUNTY MEDICAL SOCIETY, ETC., ETC 



Published by Direction of the Academy 



NEW YORK ; 
CHAS. L. BERMINGHAM & CO. 
1260 & 1262 Broadway, 
1880 




MERICAN jlCAMMY OF MEDICINE,. 

OFFICERS FOR 1880-1. 

PRESIDENT. 

EDWARD T. CASWELL, M.D., Providence, R. L 



VICE PRESIDENTS. 



H. ORLANDO MARCY, M.D., Cambridge, Mass. 
Wm. T, TAYLOR, M.D., Philadelphia, Pa. 
HOWARD PINCKNEY, M.D., New York, N. Y. 
HORACE LATHROP, M.D., Cooperstown, N. Y. 



SECRETARY & TREASURER. 



RICHARD J. DUNGLISON, M.D., Philadelphia, Pa. 



ASSISTANT SECRETARY. 



CHARLES McINTIRE, M.D., Easton, Pa. 



